During the past decade, intraoperative neural monitoring (IONM) has been accepted as a risk minimization device to avoid bilateral vocal cord paralysis (VCP) in thyroid surgery. Delaying completion surgery until nerve function has recovered (i.e.staged thyroidectomy) is a safe and logical strategy. In this study, we investigated the characteristics of patients who were staged for thyroidectomy.

In this retrospective cohort study, the data of patients who were initially scheduled for total thyroidectomy with I-IONM between 2013-2022 were analyzed. The patients who had previous thyroidectomy, those with preoperative VCP and those who had anatomically disrupted nerves during surgery were excluded. Our group has routinely preferred staged thyroidectomy, in case of true signal loss if the RLN is intact anatomically. The rate of staged thyroidectomy, the correlation between the signal loss and postoperative VCP, the recovery rate and period of nerve palsy and the necessity and rate of completion thyroidectomy were examined.

37 (4%) patients had a true signal loss and staged for thyroidectomy over a total of 922 patients. 33 (89.2%) VCPs were detected. The ratio of temporary VCP and permanent VCP in true positive signal loss group was 97% and 3%, respectively. VCP recovered in a mean of 62,2±49,7 days. Completion thyroidectomy was performed in 20 (54.1%) patients. None had bilateral VCP after completion of thyroidectomy.

Staged thyroidectomy with the proper use of I-IONM is a safe strategy for total thyroidectomy. It was needed in 4% of patients and the anatomically intact nerves recovered in a mean of 62,2±49,7 days.